Coronary Artery Disease

The Rush Approach to Coronary Artery Disease Treatment

Our heart and vascular physicians in Chicago, the suburbs and Northwest Indiana draw on their decades of experience to diagnose and treat coronary artery disease (CAD). They’ll provide you with personalized care options based on your unique needs. They can also provide you with a second opinion on your diagnosis or recommended treatments if you need one.

If you are diagnosed with coronary artery disease, your care plan may include one or more of the following:

• Help making diet changes to manage cholesterol, blood sugar and blood pressure.
• Exercise programs to reach a healthy weight and further keep your cholesterol and blood pressure in check.
• Statins, medications that lower the "bad cholesterol," called LDL, and triglycerides. These can help slow down or prevent the progression of coronary artery disease.
• Beta blockers, medications used to slow down the heart rate, reducing your heart's need for oxygen and improving the supply of blood to your heart. They have also been proven to reduce the risk of heart attacks.
• Calcium channel blockers, a group of medications that can reduce the frequency and severity of your chest pain. They are also used to help lower blood pressure.
• Aspirin to help prevent blood clots from forming.
• Other medications, such as ACE inhibitors to stop your body from producing a chemical that narrows the blood vessels.
• Percutaneous coronary intervention (PCI), or angioplasty, which involves using a balloon to open blocked arteries. A stent is often placed at the same time to keep arteries open. Some are called drug-eluting stents because they slowly release drugs directly to the arteries that can prevent scar tissue or plaque from forming.
• Atherectomy, a minimally invasive procedure performed via a catheter, or small tube. The tube runs through the artery of the wrist or groin to the area of the blockage. Then a blade or laser at the end of the catheter scrapes away plaque that has built up in the artery.
• Coronary artery bypass grafting (CABG), a surgical procedure that uses blood vessels from other parts of the body to bypass narrowed arteries and restore blood flow.
• Minimally invasive coronary artery bypass surgery, which is performed through small incisions in the chest without stopping the heart or using a heart-lung machine. It is sometimes called beating-heart surgery.
• Cardiac rehab to get you back to a healthier, active life after a heart attack or bypass surgery by getting you to create good habits of exercise and activity. This is a supervised physical therapy program that helps you regain cardiac endurance and teaches you about living with your condition.

Complex, High-Risk Coronary Artery Disease

Several types of coronary artery disease are more complex than others and require advanced care.

Rush heart and vascular specialists are experts at diagnosing and treating these cases. They have advanced imaging tools that can spot blockages in smaller blood vessels, and they can often perform minimally invasive treatments to address these diseases.

Following are some of the different kinds of complex or high-risk coronary artery diseases:

• Multivessel coronary artery disease (MVD): This happens when two or more major coronary arteries that supply blood to the heart become very narrowed, which can lead to heart attacks and heart failure.
• Chronic total occlusion (CTO): This is a complete blockage of a coronary artery, usually due to a buildup of plaque. Over time, the blockage leads to ischemia, or a lack of oxygen, in the heart tissue, and the artery walls harden. It can also lead to heart attacks and heart failure.
• Bifurcation blockage: There are some points where one coronary artery bifurcates, or splits, into two smaller arteries. These areas are important because they supply blood and oxygen to large parts of the heart muscle. When a blockage happens here, it can impair blood flow to both smaller arteries, which can lead to heart attacks.
• In-stent restenosis (ISR): Sometimes a coronary artery disease patient who had a stent placed during previous treatment may have a blockage appear again at the site of the stent. This can happen for several reasons but is often because of inflammatory responses or tissue growth. Neointimal hyperplasia happens when muscle cells grow inside the stent, causing scar tissue to form and constrict the artery.

Coronary Artery Disease Diagnosis at Rush

Diagnosing coronary artery disease starts with a conversation with your cardiologist. They will ask questions about your family history with the condition, symptoms you may have, other medical conditions you have, any previous test results or treatments and details about your lifestyle.

The first diagnostic test you have will likely be an electrocardiogram, often called an EKG or ECG. It uses small electrodes placed on your chest, arms and legs to measure the electrical signals in your heart.

Other diagnostic tests might include the following:

• Stress test: This is a test that measures the function of your heart while you’re exercising or being physically active. You may need to walk on a treadmill or ride a stationary bike during this test. It can show whether there are any problems with your blood flow. There are different types of stress tests. For example, an echo stress test uses an echocardiogram to take ultrasound images of your heart before and after exercising. A nuclear stress test uses a small amount of radioactive material given via IV and a positron emission technology (PET) scanner to take images.
• Coronary angiogram: Also called coronary catheterization, this test uses a catheter that runs through the arteries in the groin or wrist into the arteries of the heart. A small amount of contrast dye is injected through the catheter, which lets an X-ray take detailed images of the heart and coronary arteries. Physicians can sometimes perform procedures through the catheter to clear blockages from the arteries at the same time.
• Computed tomography (CT) angiogram: For this test, you’re given an injection of a special dye that can be seen with a CT scan. It can provide images of your blood vessels and show where any blockages may be.
• Coronary calcium score: This is a type of heart CT scan that measures the level of calcium in your arteries. Calcium forms when cholesterol plaque builds up, which can lead to blockages, heart attacks and other problems. 

Rush has a powerful, state-of-the-art CT scanner that very few other medical facilities have. It provides more detailed images of the blood vessels, which our specialists use to more accurately diagnose the nature and severity of any coronary artery blockages.

Coronary Artery Disease Symptoms and Types

Symptoms of coronary artery disease can include the following:

• Chest tightness, heaviness or pain, also called angina
• Shortness of breath, also called dyspnea
• Heart palpitations
• Fast heartbeat, also called tachycardia
• Fatigue
• Feeling lightheaded
• Pain that extends to your shoulders, neck, arms, upper back or jaw
• Fatigue
• Swelling of the feet or hands

The three types of coronary artery disease are as follows:

• Obstructive coronary artery disease: This is the most common type of coronary artery disease. It happens due to atherosclerosis — a buildup of plaque in the arteries that restricts blood flow.
• Nonobstructive coronary artery disease: This happens when the coronary arteries don’t show significant blockages or narrowing, but there may still be abnormalities in the blood vessels that reduce the supply of oxygen-rich blood to the heart muscle. Types of nonobstructive coronary artery disease include the following:
  • Endothelial dysfunction: This happens when there are problems in the endothelium, the thin layer of cells that line the arteries, that cause arteries to constrict instead of relax and expand.
  • Coronary vasospasm: This occurs when smooth muscle cells in the artery become overactive and suddenly spasm, constricting the coronary arteries.
  • Microvascular dysfunction: Sometimes called small artery disease, this happens when smaller blood vessels that branch from the coronary arteries don’t function as they should. They are often too small to show signs of blockage, but they can’t dilate, or expand, enough to respond to the heart’s need for blood flow.
  • Myocardial bridging: Coronary arteries usually rest on the surface of the heart, but sometimes a “bridge” of the heart muscle develops over blood vessels, and the coronary artery ends up passing through the heart instead. This often causes no issues, but in some cases, the bridge can constrict the artery as the heart pumps, reducing blood flow.
• Spontaneous coronary artery dissection: This happens when a tear appears in a coronary artery wall, causing a separation. The tear can disrupt blood flow.

Coronary Artery Disease Causes and Risks

Coronary artery disease is usually caused by atherosclerosis, a buildup of cholesterol and calcium, called plaque, along the inner walls of the arteries.

Some conditions and lifestyle behaviors linked to atherosclerosis and coronary artery disease include the following:

• High blood pressure (hypertension)
• High cholesterol
• Diabetes
• Obesity
• Sleep apnea
• Anxiety
• Depression
• Lack of exercise
• Smoking, vaping and use of other nicotine products
• Alcohol abuse

Sometimes coronary artery disease is not caused by lifestyle or related to other medical conditions. It is strongly related to genetics, and people who have a family history of blood relatives with the condition are at higher risk.

One type of coronary artery disease, spontaneous coronary artery dissection, or SCAD, has no known direct cause, but women are more likely to have it than men. It often appears after childbirth and may be influenced by hormonal changes.

Women are also more likely to have fibromuscular dysplasia, a condition that weakens arteries, which can lead to spontaneous coronary artery dissection.

Stress, genetic conditions, high blood pressure and drug abuse can also increase risks for this type of coronary artery disease.

How to Prevent Coronary Artery Disease

There are many ways to prevent coronary artery disease from developing or worsening. They include sticking to a healthy diet and lifestyle and managing other conditions and risks.

You should speak to your cardiologist about coronary artery prevention, especially if you are at high risk. They can help you make changes safely, monitor your progress and adjust any treatments as needed.

Rush also offers programs that can aid in coronary artery prevention, including programs that can help you quit smoking, start exercising and learn how to eat healthy.

Some ways to prevent coronary artery disease include the following:

• Reduce the portion size of your meals.
• Avoid processed and salty foods.
• Choose more fruits, vegetables, grains and leaner meats.
• Get at least 150 minutes of moderate to intense exercise or movement each week.
• Limit or avoid alcohol consumption.
• Avoid tobacco and nicotine products.
• Take medication to treat high blood pressure as prescribed by your cardiologist.
• Work with your physician to manage other conditions that affect coronary artery disease, such as diabetes, sleep apnea, depression and anxiety.

You can visit our “How to Prevent Coronary Artery Disease” page to learn more.

Rush Excellence in Coronary Artery Disease Care

• Among the best in the U.S.: U.S. News & World Report includes Rush on its Best Hospitals Honor Roll and ranks our cardiology and heart and vascular surgery programs among the best in the nation.
• Experts working together — for you: Our heart and vascular physicians hold conferences where specialists from many fields collaborate on patient treatment plans. These conferences include general cardiologists, interventional cardiologists, cardiac surgeons and other experts in cardiovascular care. By working together, they can make custom treatment plans that meet your unique needs.
• Renowned surgical and heart failure care: When coronary artery disease progresses or leads to heart failure, expert care can save lives. The Society of Thoracic Surgeons has repeatedly given our thoracic surgery team its highest rating possible for excellence in coronary bypass graft surgery, earned by the top 5% of participating centers nationwide. The Centers for Medicare and Medicaid Services also reports that Rush has the highest survival rates for heart failure patients in the United States.
• Surgical care and recovery: When you need surgical treatment, our cardiac surgery team knows that care goes beyond the operating room. They’re with you at every step, reducing your time spent on a ventilator, making sure you go home with the medications you need and helping you recover. Those are a few reasons why the Society of Thoracic Surgeons gives Rush a 3-star rating, its highest possible, for coronary artery bypass graft surgery.
• Cardiac care, close to home: Rush offers expert care for coronary artery disease and other heart and vascular conditions in Chicago, Aurora, Yorkville, Oak Park and Oak Brook, Illinois, as well as Northwest Indiana, bringing world-class treatment closer to where patients live.
• Treatments not offered anywhere else: Rush regularly participates in clinical trials for new coronary artery disease treatments, including new stent technology, heart monitoring tools and ultrasound-guided procedures. These treatments are often not available at other medical facilities and provide patients with alternative care options.